nursing notes

 

August is breastfeeding month in the United States and it’s a topic that is close to my heart. Pun intended. 

Thanks to decades of public health outreach and promotion, nursing is once again is a routine practice this country.  However, I absolutely believe it needs all of the organized and legal and social support it can get, because although it is the most natural thing in the world, it is at odds with a lot of values and practices in our culture, including our paradoxical modesty and the demands of the workforce.  That said, the word that it is good for babies and moms is out, so I’ll step off my soapbox for the rest of this post and share some of the most fascinating things I have learned about nursing.

• Nursing makes kids’ teeth align better.  Okay, so the studies mentioned here [http://news.health.com/2015/06/15/breast-feeding-may-have-dental-benefits-study-suggests/, http://news.bbc.co.uk/2/hi/health/4017283.stm] show significant correlation, not actual causation, but it makes a lot of sense.  The belief is that because the latch on a breast is different than on a bottle, the jaw and palate develop differently.
• Breast milk contains stem cells with “variable expression of pluripotency genes normally found in human embryonic stem cells” unlike other stem cells found in adults.   This kind of makes me wish I hadn’t thrown out the leftover frozen milk I had in the freezer in case I someday get cancer.
• From the abstract of http://www.ncbi.nlm.nih.gov/pubmed/22865647 - These findings provide evidence that breast milk represents a novel and noninvasive source of patient-specific stem cells with multilineage potential and establish a method for expansion of these cells in culture. They also highlight the potential of these cells to be used as novel models to understand adult stem cell plasticity and breast cancer, with potential use in bioengineering and tissue regeneration.
• The immune benefits are fascinating but tricky to study.  There is evidence and speculation [https://www.sciencenews.org/blog/growth-curve/backwash-nursing-babies-may-trigger-infection-fighters] that nursing babies’ saliva is backwashed and absorbed by the mother so that her immune system can create leukocytes to combat specific infections.  Inhabiting the same germy environment also contributes, of course.
• In fact, all of the purported benefits are complicated to study.  This article [http://fivethirtyeight.com/features/everybody-calm-down-about-breastfeeding/] on a statics blog Jack and I read really set me off.  It legitimately, but glibly, highlights just how difficult it is to study breastfeeding in real populations where it is unethical to assign mothers to groups and all kinds of factors affect how a particular baby is fed.  It upset me that this review assumes that breast milk and formula are equal until proven otherwise.  The assumption should be the reverse.  I believe it is healthier, even if we haven’t been able to rigorously prove it. 

I estimate that I spent over 2500 hours (10*90+4*270+2*300+1*60) nursing or pumping over the course of D’s first two years.  It was a wonderful, convenient, inconvenient, pleasant, painful and irreplaceable series of experiences that gave me a lot of time to read and reflect on the subject.   In fact, those of you who read all the way to this point should consider congratulating me on keeping this post so brief.

on pregnancy weight

A few weeks ago, I reached my pre-pregnancy weight.  It was a nice thing to see on the scale, but since it is still pretty far from my target weight, it was also a bit anti-climactic.
There's a lot of talk about pregnancy weight, but I found most of it to be supremely unhelpful.  What follows is my two or three cents on the subject.
The total -  I know a lot of new moms now, and most everyone I have talked to has put on more than the recommendation.  These are educated and moderately (if not more) active women.  This isn't really a surprise, given that so many of us struggle with our weight even prior to pregnancy.  My peers don’t smoke like previous generations did, which probably throws off some stats.  It also seems to me that some of the most active women put on the most weight because they aren’t able to keep up their normal exercise habits.
But what gets me is the recommendation.  For my pre-pregnancy weight, I was told 15 pounds would be good.  Has anyone ever put on that little?  It would mean that you'd be essentially losing weight as you gain weight....    It felt so far out of reach as to be irrelevant and various medical professionals threw out that number without much conviction.
The rate - The linear weight gain graphs are pretty useless.  The reality is as curvy as, well a pregnant lady.  Here’s what my graph of gain and loss looks like:

The measurement - Given that so much emphasis is placed on the number on the scale, you'd think that it would be measured accurately, but it is not. To keep my sanity I weighed myself at the same time in the same conditions, at home and tried to ignore the post-lunch, fully-clothed numbers at my appointments.  The difference between those two numbers was easily more than 10 pounds in a single day.  This really bugged me.

childbirth

 We are the type of people who are reassured, not petrified, by knowledge and birth was no exception.  In D’s birth I’d estimate that we used only about 5% of what we learned, but I absolutely don’t regret the time we spent learning it.  Plus you never know which 5% it might come in handy.

Midwives and Natural Birth

Based on some of my earlier reading we switched to a midwifery group, rather than an OB group, in the fall.  I expected to get some criticism or strange looks from people, but we didn’t encounter that at all.  For us, planning to deliver with a midwife in a hospital was a perfect middle way in the spectrum of possibilities.  We wanted a provider who would be more involved, more supportive of natural birth and less likely to encourage interventions that might not be necessary.  The fact that midwives are all (?) women was an added bonus.

The primary reason we hoped for a natural birth is the “cascade of interventions” we read about which can be initiated by using pain medication.  For example, when you’re hooked up to tubes and wires you’re less able and likely to move around, which can make it more likely for the baby to be malpositioned.  When you can’t feel the urge to push, the pushing stage of labor takes longer.   When it takes longer, you’re more likely to be exhausted.  When the baby is “stuck” and you’ve been at it for hours and hours, more and more interventions become necessary.  I also preferred to minimize the drugs ingested by our newborn. 

So we were aiming for a natural birth, but we really had no idea if it was realistic.  If we learned anything in the months leading up to D’s birth, it’s that there are millions of storylines that result in a healthy baby and that the plot is largely out of our control.

When our classes discussed coping with pain, it was hard to relate.  How can you know what kind of pain tolerance you have and whether your most painful experiences relate in any way to the anticipated pain of birth? The most physically painful experience I could recall was tearing my ACL (knee ligament) when I was 17, but it was incredibly difficult to actually remember the sensations, which is probably for the best.  When I thought about the concept of coping, my first Montreal winter leapt to mind.  For better or worse, my mental refrain was “it’s just going to get worse, it’s just going to get colder” and before I knew it five months had passed and I was enjoying the balmy 1 degree Celsius weather at a Saint Patrick’s day parade and getting some color in my face from finally spending more than 10 minutes outdoors.  I really do remember feeling warm at that parade. 

Birth Story

Fast forward to 10 days after D’s due date.  We went in to the hospital at 8 am for our scheduled induction.  We knew I was already significantly dilated but I still wasn’t feeling the contractions, though they had been happening for weeks. 

They started me on the hormone Pitocin at 10 am to strengthen the contractions.  It worked.  We walked around a little bit.  Then we played a card game I particularly like.  Then I threw up, which is one of the lowest points of my memories.  Then my water broke and things progressed rapidly from there. 

At 2 pm they stopped the Pitocin due to fluctuations in D’s heart rate.  I was happy to let my body set the pace because the contractions continued with a bit more time in between them. 

At 6 pm D was born after less than an hour of pushing, which is apparently pretty quick for a large, first-born baby.  I am so grateful that the part of labor I felt lasted only as long as a workday. 

So what were the coping techniques we used?

• Jack held my hand pretty much the whole time
• I took off my glasses and closed my eyes somewhere in the middle, leaving me with a type of inner focus I’ve never otherwise experienced, and no concept of time.  I rested like a champ between contractions, and it felt like the kind of near-sleep where your eyes roll back a little bit.
• I did deep breathing.
• I made a few sounds and did a little bit of counting but didn’t really get into a rhythm with them.
• I focused on keeping my lips and my facial muscles loose, because they say that if your face is loose, so are the muscles of  your you-know-what.
• In the last few hours, the visuals that spontaneously came to me were imagining myself as a puddle of mercury on the floor or a melting glacier. 

I would say that my Montreal winter pessimism method worked.  It did get more painful, but I still had something left when it was over.  In other words it was not a 10 out of 10 on the pain scale.

It was really important to me to know that the drugs were available if I wanted them.  I think that actually helped me focus.

The teacher of our birth class, Penny Simkin, made a super important distinction between pain and suffering.  Pain is physical but suffering encompasses your whole self.  My suffering was minimal.   I didn’t feel fear at all.  I didn’t think I would split in half or that D wouldn’t make it.  Jack didn’t think I was dying.  I had no desire to lash out at the people around me.

Support People

At both the midwifery practice and the OB practice, patients have appointments with several practitioners during pregnancy and then deliver with who ever is on call.  The labor and delivery nurses are the ones who take care of you most of the time, which I didn’t realize until I started reading in the fall.  It has also become popular to have a doula, which is a non-medical labor support person.  Having a doula has been shown to improve and speed up birth, so we considered it but opted not to because we didn’t want to work the dynamics of a new relationship.

Doulas are particularly helpful for laboring at home before going to the hospital, a typical step that we completely skipped.  Since our induction was a normal business hours affair, we actually had a student nurse and a student midwife, in addition to our primary nurse and midwife so we had a full room of absolutely phenomenal support.  We had met the primary midwife once or twice before and it really didn’t matter that we hadn’t met the others.

Saving the best for last, Jack was the most incredible support person I could imagine.  He was calm, consistent, informed and familiar.  I think the only time he let go of my hand was when he caught D at the moment he was born and put him on my chest. 

 

One month later, D’s birth is a treasured memory.

rainfall comparison and the Sequim Banana Belt

We spent the holiday weekend in Sequim, hoping for a little break from the typical winter rain.  As it turns out, a storm went through most of Western Washington, so it didn’t really work out to be a dry weekend.  On the bright side, we did have clear weather for most of Sunday so we walked Dungeness Spit and the bluffs nearby.

thank you, William Pollack

I've learned a lot about pregnancy, birth and human development in the last few months of reading, but the thing that has surprised me most is the severity of Rh disease.  I had heard of this blood type incompatibility before, but now have a very personal motivation to understand it better.